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Deficiency Records for Sunset Home
A list of the most recent deficiencies for Sunset Home. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.
A list of the most recent deficiencies for Sunset Home. The list is based on the information provided by CMS from both standard inspections and from complaints filed by residents.
| Deficiency | Type of Deficiency | Deficiency Date | Date Corrected | Resulted from a Complaint? |
|---|---|---|---|---|
| Have an enclosure around a vertical opening shaft. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Have properly installed hallway dispensers for alcohol-based hand rub. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Have a complete alarm system manually initiated and initiated by fire sprinkler system connection. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Have approved installation, maintenance and testing program for fire alarm systems. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Install smoke barrier doors that can resist smoke for at least 20 minutes. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Have simulated fire drills held at unexpected times. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Ensure proper usage of power strips and extension cords. | Fire Safety | 2024-08-14 | 2024-09-19 | N |
| Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Health | 2024-08-14 | 2024-09-18 | N |
| Develop and implement policies and procedures to prevent abuse, neglect, and theft. | Health | 2024-08-14 | 2024-09-18 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2024-08-14 | 2024-09-18 | N |
| Notify the resident or the resident?s representative in writing how long the nursing home will hold the resident?s bed in cases of transfer to a hospital or therapeutic leave. | Health | 2024-08-14 | 2024-09-18 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2024-08-14 | 2024-09-18 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2024-08-14 | 2024-09-18 | N |
| Provide activities to meet all resident's needs. | Health | 2024-08-14 | 2024-09-18 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2024-08-14 | 2024-09-18 | N |
| Provide care or services that was trauma informed and/or culturally competent. | Health | 2024-08-14 | 2024-09-18 | N |
| Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | Health | 2024-08-14 | 2024-09-18 | N |
| Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | Health | 2024-08-14 | 2024-09-18 | N |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2024-08-14 | 2024-09-18 | N |
| Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. | Health | 2024-08-14 | 2024-09-18 | N |
| Observe each nurse aide's job performance and give regular training. | Health | 2024-08-14 | 2024-09-18 | N |
| Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | Health | 2024-08-14 | 2024-09-18 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2024-08-14 | 2024-09-18 | N |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | Health | 2024-08-14 | 2024-09-18 | N |
| Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | Health | 2024-08-14 | 2024-09-18 | N |
| Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | Health | 2024-08-14 | 2024-09-18 | N |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. | Health | 2023-11-03 | 2023-12-01 | Y |
| Use approved construction type or materials. | Fire Safety | 2023-01-19 | 2023-04-13 | N |
| Provide properly protected cooking facilities. | Fire Safety | 2023-01-19 | 2023-04-13 | N |
| Inspect, test, and maintain automatic sprinkler systems. | Fire Safety | 2023-01-19 | 2023-04-13 | N |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Fire Safety | 2023-01-19 | 2023-04-13 | N |
| Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | Health | 2023-01-19 | 2023-03-05 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2023-01-19 | 2023-03-05 | N |
| Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Health | 2023-01-19 | 2023-03-05 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2023-01-19 | 2023-03-05 | N |
| Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Health | 2023-01-19 | 2023-03-05 | N |
| Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | Health | 2023-01-19 | 2023-03-05 | N |
| Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Health | 2023-01-19 | 2023-03-05 | N |
| Provide and implement an infection prevention and control program. | Health | 2023-01-19 | 2023-03-05 | N |
| Meet other general requirements. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| Have properly installed electrical wiring and gas equipment. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| Have generator or other power source capable of supplying service within 10 seconds. | Fire Safety | 2023-01-19 | 2023-03-05 | N |
| PASARR screening for Mental disorders or Intellectual Disabilities | Health | 2022-05-05 | 2022-06-11 | Y |
| Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | Health | 2022-05-05 | 2022-06-11 | Y |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2022-05-05 | 2022-06-11 | Y |
| Keep aisles, corridors, and exits free of obstruction in case of emergency. | Fire Safety | 2022-05-05 | 2022-06-10 | Y |
| Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | Health | 2019-11-08 | 2019-12-23 | N |
| Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | Health | 2019-11-08 | 2019-12-23 | N |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Health | 2019-11-08 | 2019-12-23 | N |
| Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Health | 2019-11-08 | 2019-12-23 | N |
| Ensure services provided by the nursing facility meet professional standards of quality. | Health | 2019-11-08 | 2019-12-23 | N |
| Provide care and assistance to perform activities of daily living for any resident who is unable. | Health | 2019-11-08 | 2019-12-23 | N |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Health | 2019-11-08 | 2019-12-23 | N |
| Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | Health | 2019-11-08 | 2019-12-23 | N |
| Provide safe and appropriate respiratory care for a resident when needed. | Health | 2019-11-08 | 2019-12-23 | N |
| Ensure medication error rates are not 5 percent or greater. | Health | 2019-11-08 | 2019-12-23 | N |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Health | 2019-11-08 | 2019-12-23 | N |
| Provide and implement an infection prevention and control program. | Health | 2019-11-08 | 2019-12-23 | N |
| Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. | Fire Safety | 2019-11-08 | 2019-12-23 | N |
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